Lupus anticoagulant as a predictor of adverse pregnancy outcomes

In recent years, the influence of autoimmune pathology on fetal loss and other pregnancy complications has been widely discussed. Lupus anticoagulant (LA), an immunoglobulin that binds to phospholipids and proteins associated with the cell membrane is said to be responsible for such complications. The purpose of the study was to identify LA autoimmune disorders in pregnant women, to determine its influence in predicting adverse pregnancy outcomes, to evaluate the prophylactic efficacy of acetylsalicylic acid and dipyridamole antiplatelet doses, which had been prescribed for LA-positive pregnant women. Material and Methods. The high risk group included 125 women with adverse pregnancy outcome hospitalized with a threatened miscarriage. Preeclampsia, as well as 2-8 early abortions, was peculiar to obstetric history of such patients. All women were tested according to clinical classification of systemic lupus erythematosis (American College of Rheumatology). LA in the venous blood of patients was determined by a coagulation test with diluted tissue thromboplastin (DTT). LA-positive women took acetylsalicylic acid (125 mg/day) and dipyridamole (150 mg/day). Results. According to DTT test, 62 (49.6 %) patients were LA-positive. In 8 (7.8 %) cases severe preeclampsia developed in pregnant women, in 6 cases it was found in LA-positve women. Preventive medication was accepted by 24 LA-positive women. Their pregnancies ended in term births, 3 newborns (12.6 %) demonstrated hypotrophy, stage 1. In untreated women, 16.7 % of pregnancies ended in spontaneous miscarriages; among 20 life-birth infants 25 % died in the early neonatal period; 40 % of babies were born with hypotrophy (p=0.0259); the level of perinatal losses was 35 %. Conclusion. LA was detected in 49.6 % if women with repeated pregnancy loss were tested using coagulation probe DTT. LA-positive women had 68.5 % miscarriages in the past. LA in pregnant preeclamptic women is a statistically and clinically significant high risk factor, which can lead to further preeclampsia development, relative risk is 4.5.